What are the different types of orthotics for foot problems? How do you wear shoe inserts and orthotics properly? Get expert tips on addressing foot issues with the right orthotic devices.

Understanding Orthotics for Foot Problems

When your feet are aching, a simple shoe insert may provide the relief you need. However, in some cases, you may require a more specialized device called an “orthotic.” Orthotics are prescription medical devices designed to correct biomechanical issues with your feet, ankles, and even legs.

The key differences between over-the-counter shoe inserts and custom orthotics are the level of personalization and the intended purpose. Inserts are general, off-the-shelf products that aim to add cushioning and support, while orthotics are custom-molded to your feet to address specific problems.

What Your Podiatrist Will Check

To determine if you need orthotics, your podiatrist will conduct a thorough examination. This typically includes taking 3D images of your feet and observing how you walk, stand, and move your feet, ankles, legs, and hips. The podiatrist uses this information to identify any underlying biomechanical issues that may be causing your foot pain or discomfort.

Types of Orthotics

There are two main categories of orthotics: rigid (or functional) and soft (or accommodative). Rigid orthotics are made from materials like plastic or carbon fiber and are designed to ease foot, leg, and back pain by correcting gait issues. Soft orthotics, on the other hand, are made from cushioning materials to relieve pressure on sore or uncomfortable areas, such as those affected by conditions like plantar fasciitis or diabetic foot ulcers.

How to Wear Inserts and Orthotics

Whether you opt for over-the-counter inserts or custom orthotics, the key is ensuring a proper fit. Inserts should conform to the contours of your shoe and feel comfortable, without rubbing or causing discomfort. Prescription orthotics made from molds of your feet should fit snugly but not cause any irritation.

Cost and Insurance Coverage

Orthotics typically cost more than generic shoe inserts, but they also come with a professional evaluation, custom fit, and higher-quality materials. Since orthotics are considered prescription medical devices, your health insurance may cover some or all of the cost, depending on your plan.

Follow-Up Care

After receiving your orthotics, it’s important to follow up with your podiatrist to ensure they are working effectively for you. If you experience any issues or discomfort, be sure to let your podiatrist know so they can make any necessary adjustments.

Key Takeaways

• Shoe inserts provide general cushioning and support, while orthotics are custom-made to address specific foot, ankle, and leg problems.
• Podiatrists evaluate your feet, including how you walk and move, to determine if you need orthotics.
• Rigid orthotics are designed to correct gait issues, while soft orthotics provide cushioning for sore or uncomfortable areas.
• Proper fit is crucial for both inserts and orthotics to be effective.
• Orthotics may be covered by health insurance, as they are considered prescription medical devices.
• Follow-up appointments with your podiatrist are important to ensure your orthotics are working properly.

What are the main types of orthotics, and how do they differ in their purpose and construction? Orthotics can be categorized into two main types: rigid (or functional) orthotics and soft (or accommodative) orthotics. Rigid orthotics are made from materials like plastic or carbon fiber and are designed to correct issues with how you walk, stand, or run, helping to ease pain in the feet, legs, and lower back. Soft orthotics, on the other hand, are made from cushioning materials to provide relief for sore or uncomfortable areas, such as those affected by conditions like plantar fasciitis or diabetic foot ulcers.

How does the fitting process for orthotics differ from over-the-counter shoe inserts? The fitting process for custom orthotics is much more involved than for generic shoe inserts. To get orthotics, your podiatrist will first take 3D images of your feet and conduct a thorough examination to identify any underlying biomechanical issues. They then use this information to create a precise mold of your feet, which is then used to manufacture the custom orthotics. This ensures a perfect fit and addresses your specific foot problems. In contrast, over-the-counter shoe inserts are generic products that may provide some general cushioning and support, but they are not tailored to the unique characteristics of your feet.

What factors should you consider when deciding between over-the-counter inserts and custom orthotics? The main factors to consider are the nature and severity of your foot problem, as well as the level of personalization and quality of the device. Over-the-counter inserts can be a good option for minor issues or if you just want some additional cushioning and support. However, if you have a more serious biomechanical problem or a condition like plantar fasciitis or diabetes-related foot issues, custom orthotics may be the better choice. Orthotics provide a higher level of personalization and are made with higher-quality materials, which can make them more effective at addressing the root cause of your foot pain or discomfort.

How can you ensure that your orthotics or shoe inserts fit properly and provide the intended benefits? Proper fit is crucial for both orthotics and over-the-counter inserts to be effective. For inserts, you’ll want to make sure they conform to the contours of your shoe and don’t cause any rubbing or irritation. With custom orthotics, the fit should be snug but not uncomfortable. If you experience any issues with the fit, be sure to let your podiatrist know so they can make any necessary adjustments. Additionally, it’s important to follow any wear and care instructions provided to ensure your orthotics or inserts continue to provide the intended support and relief.

When should you consider seeing a podiatrist for orthotics, and what can you expect during the evaluation? You may want to see a podiatrist if you are experiencing persistent foot pain or discomfort that is not alleviated by over-the-counter solutions. During the evaluation, the podiatrist will likely take 3D images of your feet and observe how you walk, stand, and move your feet, ankles, legs, and hips. This allows them to identify any underlying biomechanical issues that may be causing your foot problems. Based on this assessment, the podiatrist can then determine if custom orthotics are recommended and work with you to create a precise mold of your feet for the manufacturing process.

How do the costs of over-the-counter inserts and custom orthotics compare, and what factors influence the cost of orthotics? Over-the-counter shoe inserts are generally less expensive than custom orthotics, typically ranging from $10 to $50. In contrast, custom orthotics can cost anywhere from $200 to $800 or more, depending on the complexity of the device and the materials used. The higher cost of orthotics is due to the professional evaluation, custom fitting, and higher-quality materials involved. However, since orthotics are considered prescription medical devices, your health insurance may cover some or all of the cost, depending on your plan. It’s important to check with your insurance provider to understand your coverage and out-of-pocket expenses for orthotics.

What is the typical process for follow-up care and adjustments with custom orthotics? After receiving your custom orthotics, it’s important to follow up with your podiatrist to ensure they are working effectively for you. Your podiatrist may want to see you for a follow-up appointment a few weeks or months after you start using the orthotics to evaluate their performance and make any necessary adjustments. This could involve minor tweaks to the fit or additional modifications to the device to optimize its function and provide the intended relief. If you experience any issues or discomfort with your orthotics, be sure to let your podiatrist know so they can address the problem and make sure you’re getting the full benefit of the custom device.

Shoe Orthotics for Foot Problems: Types & Tips

Written by Jodi Helmer

• What Your Podiatrist Will Check
• Types of Orthotics
• How to Wear Inserts and Orthotics

Are your feet aching again? Are you wondering if a simple shoe insert might help? It might. But depending on what the problem is, you could need an “orthotic” instead.

• Inserts that you can buy in stores without a prescription can provide cushioning and support. They may be made of materials like gel, plastic, or foam. Inserts fit into your shoes. But they’re not custom-made for your feet. They can provide arch support or extra cushioning on the heel, around the toes, or for your entire foot. Inserts might make your shoes more comfortable but aren’t designed to correct foot problems.
• Orthotics are different. They are prescription medical devices that you wear inside your shoes to correct biomechanical foot issues such as problems with how you walk, stand, or run. They can also help with foot pain caused by medical conditions such as diabetes, plantar fasciitis, bursitis, and arthritis. Orthotics might even help you avoid surgery to fix flat feet.

Still, you might not need the prescription medical devices. Sometimes, an over-the-counter shoe insert will work just fine. You’ll want to ask a podiatrist, a doctor specializing in foot care, for their recommendation.

During an appointment, your podiatrist will take 3D images of each foot and do a thorough examination. That might include watching you walk and noting how your feet, ankles, legs, and hips move.

If you need orthotics, your podiatrist will make a precise mold of your feet. This is important to get the right fit. Once the mold is ready, a professional will turn it into rigid or soft orthotics.

Rigid orthotics, or “functional orthotics,” are made from materials like plastic or carbon fiber. They’re best for walking shoes or dress shoes with closed toes and low heels. This kind of orthotic is designed to ease foot aches and strains as well as pain in the legs, thighs, and lower back that you might feel if your foot doesn’t work like it should.

Soft orthotics, or “accommodative orthotics,” are made from soft compression materials. They provide cushioning to take the pressure off uncomfortable or sore spots from conditions such as plantar fasciitis or diabetic foot ulcers. Because of their bulk, you might need to wear soft orthotics with prescription footwear.

You can also get special orthotics designed for sporting equipment such as ski boots and ice skates.

Both over-the-counter inserts and custom orthotics should fit the contours of your shoe and feel comfortable. A packaged insert that rubs your foot in the store won’t get better at home. Prescription orthotics made from molds of your feet should fit quite well. If they don’t, tell your podiatrist.

Orthotics cost more than inserts. But when you get orthotics, you’re also getting a medical evaluation of your foot problem, a custom fit, and high quality materials that should last for several years with proper care. Since orthotics are prescription medical devices, your insurance company might help cover the cost. Check your plan.

You’ll need to schedule a follow up appointment with your podiatrist to make sure your orthotics work well for you. Hopefully you’ll find that your feet feel better. If not, be sure to let your podiatrist know.

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What Is Posterior Tibial Tendon Dysfunction?

Written by Venkat S.R.

• What Is Posterior Tibial Tendon Dysfunction?
• PTTD Causes
• Posterior Tibial Tendon Dysfunction Symptoms
• How Is Posterior Tibial Tendon Dysfunction Diagnosed?
• Posterior Tibial Tendonitis Treatment
• Posterior Tibial Tendonitis Recovery Time
• More

Posterior tibial tendon dysfunction is a painful condition that affects your foot and ankle. This article will look at the causes and symptoms of this condition. It will also detail the methods used to diagnose and treat the condition, including surgical and nonsurgical treatment options.

The tendons in your body connect your bones to your muscles and extend along the joints to help you carry out bending movements. One such tendon is the posterior tibial tendon. This tendon originates in the calf and extends down to the inner part of the ankle, where it is connected to the bone in the middle of your foot. 

The primary responsibility of the tendon is to support the arch of the inside of the foot. This helps you step on your toes as you walk. 

Posterior tibial tendon dysfunction (PTTD) is a condition that leads to inflammation or a tear in this tendon. When the tendon is damaged, it can no longer support the arch. This condition is also known as posterior tibial tendonitis or posterior tibial tendon insufficiency, and it can cause acute pain in the foot and ankle. An inflamed posterior tibial tendon can also impede specific foot and ankle movements, such as standing, walking, running, and standing on your toes.

The inability of the tendon to support the arch of the foot leads to a condition known as a “flat foot.” The American Academy of Orthopaedic Surgeons defines a flat foot as a condition in which the foot’s arch lies flat on the inner side and the foot points outwards. PTTD is one of the most widely reported causes of acquired flatfoot in adults.

PTTD typically occurs in four stages.

• Stage 1. In the first stage, the tendon is stretched but not damaged and causes pain in the instep, especially when walking. Sometimes, the tendon may swell, but you’ll still be able to stand on your toes on a single leg.
• Stage 2. In this stage, the tendon is torn to some extent, and the pain and swelling become more severe. The flat foot becomes more prominent in this stage, and you’ll be unable to stand on your toes on one leg.
• Stage 3. Your foot will be considerably deformed, and you’ll lose flexibility in your heel.
• Stage 4. This is the most severe stage of posterior tibial tendon dysfunction. In this stage, the ankle and the foot both become deformed, and you may experience arthritis in the ankle.

A major injury caused by a fall could lead to a tear or inflammation in the posterior tibial tendon. The tendon can also rupture due to extensive use. This is usually the case in athletes participating in high-impact sports or activities like tennis, soccer, basketball, or long-distance running. If the tendon tears or is inflamed, the arch will slowly collapse.

Other risk factors include:

• Obesity
• Hypertension
• Diabetes
• Steroid use
• Previous surgery in the area
• Conditions like Reiter’s syndrome that cause inflammation
• Too much force placed on the foot (for instance, when running on an inclined road)
• Tissue injuries in the foot or ankle
• Existing joint conditions

Additionally, as you grow older, the tendon becomes weak or can break down completely. That’s why PTTD is more common in women and people over 40. Instances of younger people reporting this condition are rare but can still occur due to an injury. 

Some of the common symptoms of PTTD are:

• Swelling on the inner or outer part of your ankle and foot
• Collapse of the arch
• Inability to stand on the toes
• Difficulty walking on uneven surfaces
• Difficulty going up and down stairs
• Shoes on one foot wearing out differently than those on the other
• Pain when you stand on your toes
• Pain and swelling along the inside of your foot and in the ankle (worse when you do any activity like standing or walking) 
• Inward rolling of the ankle
• Pain on the outside of the ankle (caused by the collapsing of the foot, which puts added pressure on the outside ankle bone)
• Foot and toes beginning to turn outward

Your doctor will base the diagnosis on a physical examination and medical history. A foot and ankle surgeon may inspect the area. These specialists will ask you to perform specific movements to check whether your heel and ankle are functioning properly.

One such test is the single-limb heel raise. In this, you’ll need to stand with your back to the wall, raise your healthy foot in the air and then stand on the toes of the affected leg. If your heel rolls inward, that’s a sign that your heel is okay. If it doesn’t, that’s an indication of posterior tibial tendon dysfunction. The doctor may also notice whether you can complete eight to 10 raises without discomfort. Even in the second stage of PTTD, you’ll be unable to complete even one heel raise.

Another test to diagnose the condition is the “too many toes” sign. Here, the doctor observes your foot from behind to identify whether the foot’s arch is flat or if the toes point outward. When you look at a normal foot from behind, you can usually see only the fifth toe (called the pinky toe) and a portion of the fourth toe (called the ring toe) on the outside. If you have PTTD, though, your doctor may be able to see more toes projecting out.

Your doctor may perform additional tests such as an x-ray, MRI, ultrasound, or CT scan to help with the diagnosis. These scans can identify joint and tendon degeneration and locate possible fluid build-up in the tissues surrounding the tendon, which are all signs of early PTTD.

Your doctor will decide on the best treatment depending on the severity of your symptoms. If your doctor detects damage to the tendon in the early stages of PTTD, that allows them to treat the condition non-surgically. This usually includes:

• Immobilization. Your leg will be placed in a cast or a walking boot for roughly two months to reduce inflammation and aid healing.
• Braces. A custom-made ankle brace may support the ankle and the foot in the initial stages of PTTD. This reduces the strain placed on the tendon and could help avoid surgery in some cases.
• Medicines. Your doctor may prescribe non-steroidal anti-inflammatory drugs like aspirin and ibuprofen to manage the pain and inflammation. Steroids (cortisone) may also be prescribed sometimes. Make sure that your doctor is aware of your medical history and any other medications that might interact with these drugs. 
• Physical therapy. Therapy and adequate rest help strengthen the muscles and tendons around the affected area.
• Orthotics. These are medical devices prescribed by your doctor. They are typically shoe inserts that support your arch and tendon. Sometimes, your doctor may prescribe a cast or an orthotic brace customized for your foot.

If nonsurgical treatments don’t reduce your pain after six months, you may need to explore surgical methods to treat the condition. A specialist will determine the best treatment depending on the location of the pain and the extent of the tendon damage. 

Some surgical options may include:

• Tenosynovectomy. This treatment involves cleaning the tendon by removing any inflamed tissue around it. Surgeons take this option in mild PTTD cases.
• Osteotomy. This surgery realigns your heel bone. Sometimes, this may involve removing a part of the bone.
• Tendon transfer. This surgery removes healthy fibers from another tendon to replace those in the affected posterior tibial tendon.
• Arthrodesis. This is the process of fusing two or more bones to prevent movement of the affected joint. It helps prevent the condition from worsening.

PTTD is a painful condition that generally takes a few months to heal. As your foot heals, you’ll have to change your daily routine and take precautions before you ease back into your normal activities.

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The transverse arch of the foot was the most important for its longitudinal stiffness

40 percent of the stiffness of the human foot is provided by its transverse arch, reported in Nature . Previously, it was believed that in order to maintain the shape of the foot, its largest arch, the medial longitudinal arch, is most important. New data will help to reconsider the views on the development of bipedalism in human ancestors.

When walking, a person leans on the entire foot. For effective repulsion from the support, the middle part of the foot must be sufficiently rigid. This rigidity is provided by two arches – medial longitudinal (there are other longitudinal ones) and transverse. They are formed by the bones of the metatarsus and tarsus, as well as ligaments and muscles.

In most bipedal studies, the authors paid attention to the medial longitudinal arch as the largest. However, it is not entirely clear how the height of the medial longitudinal arch affects the stiffness of the foot: for example, people with strong longitudinal flat feet, in whom it is almost not expressed, can often walk quite normally by rolling from heel to toe, that is, reduced stiffness of the foot seems to them does not interfere. In addition, in theory, the transverse vault can partially provide it: if you bend a sheet of paper across, it will withstand a greater load at one of its ends than if you leave it flat.

Therefore, scientists from Yale University, the Swedish Northern University of Theoretical Physics, the University of Warwick and several others collected measurements of the transverse arch of the foot from human volunteers, chimpanzees, gorillas (data from the literature) and several extinct species of hominids ( Homo naledi , Homo habilis and others; from photographs of bones). The researchers were especially interested in the position of the fourth metatarsal bone.

In addition, the authors had donor material at their disposal – frozen legs of deceased women aged 55 and 64. They were put to the test: they were placed on two platforms and loaded in such a way as to imitate the mass of a human body. The stiffness of the feet was measured in the whole state and after transection of part of the ligaments that support the transverse arch.

Tests of real legs have shown that when the transverse arch of the foot is damaged, its stiffness does drop, moreover, under high load – more than 40 percent. This is much more than you might expect. And measurements of the arches of the feet and the position of the fourth metatarsal bone in various species made it possible to deduce the angle of bending of the same arch, at which it begins to play a significant role in the stiffness of the foot – and, probably, to ensure upright walking. According to researchers, such an angle was observed in Australopithecus one and a half million years before the emergence of the genus Homo .

It turns out that the transverse arch of the foot may be more important for upright walking. This means that it could also occur in those who did not yet have a well-developed longitudinal arch. In addition, the authors say their data could help develop shoes for correcting flat feet and study human locomotion, as well as change some approaches to the creation of robotic limbs.

However, for upright walking, the shape of not only the feet, but also the spine is important. One of the changes in the structure of the spinal column, which ensured the upright posture of human ancestors, is considered to be the shortening of the thoracic region from 13 to 12 vertebrae. The oldest known find of a hominid with 12 vertebrae of the thoracic region is 3.3 million years old, these are the remains of Australopithecus from Ethiopia.

Svetlana Yastrebova

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How to distinguish a fracture from a bruise: first aid for an ankle injury

Ankle and ankle injuries account for the lion’s share of all injuries of the musculoskeletal system. The proportion of ligament tears in the structure of sports injuries can reach up to 40%. Bruising, damage to the ligaments and bones of the joint can be caused by muscle imbalance, defects in shoes or coatings, changes in the nervous system, or banal inattention. Depending on the amount of damage, the recovery prognosis can vary dramatically. To understand the principles of helping with ankle injuries, it is worth understanding the types of injuries.

Content

• Bruise
• Torn and torn ligaments
• Fractures
• Ankle Injury Prevention
• First Aid for Ankle Injury
• Modern solutions for treatment and rehabilitation

Injury

Banal bruise – a consequence of a kick on a hard object. In this case, as a rule, serious destruction of body tissues is not observed. Bruises on the lower leg and ankles are very painful, since the bones in this area are devoid of a protective fatty cover. Recovery from a minor injury is often quick. Extensive damage can cause massive edema, bruising, or even injury to blood vessels and nerves. However, most often a “normal” bruise is accompanied by only moderate pain and minor swelling.

Tears and ruptures of ligaments

Tears and ruptures of the ligaments of the ankle joint are the most extensive group of ankle injuries. In the typical direction of “tucking” the foot, 1, 2 or 3 lateral ligaments are injured. It should be noted that the ligaments are characterized by low elasticity. When overloaded, they do not stretch, but break completely or partially. The rupture is accompanied by pain, swelling, sometimes a crunch or crack. In the future, the ligaments may grow together or lose their tension. Small partial tears with the right approach have a very favorable prognosis. Complete ruptures of multiple ligaments often result in chronic instability and re-injury.

fractures

Even a small fracture is a potentially severe injury that requires a special approach. Among the fractures of the ankle joint, the following types are most common:

• isolated fracture of the lateral malleolus,
• bimalleolar fracture,
• bimalleolar fracture with fracture of the posterior edge of the tibia,
• fracture of the lower third of the leg bones.

To determine the prognosis and treatment tactics, the degree of displacement of fragments and the location of the zone of bone destruction are of great importance. Allocate fractures without displacement – “cracks” of the bone, and complex injuries with displacement of fragments. Severe fractures can be complicated by ruptures of blood vessels, nerves and ligaments. The outcome largely depends on the correctness of the provision of first and specialized care, adequate and complete rehabilitation.

Prevention of ankle injuries

Ankle injuries can be caused by:

• falls from a height,
• traffic accidents,
• industrial accidents
• simple negligence or negligence,
• muscle imbalance.

Despite a certain influence of factors beyond our control, the largest percentage of fractures and ruptures of the ankle ligaments is associated only with chronic muscle overload and imbalance. Most patients with fractures and severe ruptures recall that before that their foot had repeatedly “twisted” – the muscles seemed to be turned off. Timely restoration of the balance of the muscles of the lower leg and foot is the basis for the prevention of torn ligaments and ankle fractures. To strengthen the musculoskeletal apparatus of the legs, the so-called balance training has proven itself. The technique is actively used in sports medicine for training and rehabilitation of football players, gymnasts, and speed skaters. You can carry out balance training at home on a special balancing pillow.

Working with the right certified balance cushion after a few minutes gives a feeling of stability, pleasant working out and massage of the foot and lower leg. Regular exercise leads to strengthening the ankle and improving the balance of the whole body. Very often, various deformities of the foot lead to rupture of the ligaments. Excessive pronation or supination, valgus or varus of the heels are corrected with individual orthopedic insoles. These products directly correct musculoskeletal imbalance, improve blood circulation and perception of the foot and ankle area.

First aid for ankle injury

Seek immediate medical attention for any injury, who can accurately diagnose and recommend effective treatment. For bruises and small torn ligaments, the RICE protocol has proven itself:

R (rest – rest): stop stepping on your foot, provide it with complete rest.

I (ice – ice, cold): for the first few days it is useful to apply an ice bottle or cold accumulator to the injury site. It is worth doing this for 10-20 minutes every 2-3 hours. A cold object should separate a small layer of tissue from the skin to avoid frostbite.

C (compression): to prevent swelling in the daytime, you can wrap the foot and lower leg with an elastic bandage (not tight!). Compression stockings are even better.

E (elevation): Lie more for the first few days, rest your foot on pillows to give it a slightly elevated position. So she will swell and hurt less. Serious ruptures, fractures require immediate fixation of the limb, sometimes surgery can be used.

Modern solutions for treatment and rehabilitation

Special orthoses can help with typical bruises and torn ligaments. Ankle braces tangibly reduce pain and swelling, speed up healing, and allow you to return to your active life earlier. Experienced consultants in ORTO SMART – Medtechnika, orthosalon stores will help you choose the best orthosis for your case. Depending on the indications, modern clamps of our network can perform:

• gentle compression for a noticeable reduction in pain and swelling,
• gentle support to stimulate your own muscles and receptors,
• moderate fixation for fast ligament healing and mobility,
• rigid fixation to stabilize severe damage.

In case postoperative fixation is required, convenient and comfortable splints are always available. Modern plastic splints are lighter than outdated plaster casts, they allow you to actively move and carry out hygienic treatment of the skin, change the angle and degree of fixation. It is important to understand that even after successful healing, the damaged area remains quite vulnerable.